Case Studies for the Treatment of Cervicogenic or Vertebrogenic Headaches

by: Jerome M. True, D.C., DABCN

Headaches that rapidly resolve following chiropractic treatment should empirically be
classified as vertebrogenic or cervicogenic. One would think that headaches originating
from the cervical spine would all be termed a "cervicogenic headache" however,
cervicogenic headaches have criteria that limits its use for diagnosis. (This criteria
really should be changed to reflect current scientific understanding and variability of
the cervicogenic category).

The classic definition of cervicogenic headache was originally proposed by Sjaastad in
1983. It has 3 criteria (1) unilateral headache triggered by head/neck movements or posture;
(2) unilateral headache triggered by pressure on the neck; (3) unilateral headache spreading
to the neck and the homolateral shoulder/arm. This classification of headache is still not
accepted by The International Headache Society (IHC). Rather than recognizing this obvious
form of headache, the IHC labels these headaches as a subset etiology of the tension-type
headache or a variant of chronic daily headaches (CDH).

The post traumatic patient may be diagnosed with new daily persistent headache (NDPH) a
recent classification for headaches having multiple etiologies such as headache from
post-concussion, subarachnoid hemorrhage, recent infection or other relatively rare
disorders. The cervicogenic headache is one of the few types of headache where the source
of pain originating from the reflexive pain generators in the spine can clearly and
convincingly be identified based on segmental localization. Although the provocative cause
of many headaches may be evident such as lumbar puncture headache, meningitis headache,
toxic triggers or post concussion headache, the mechanism of pain production in most
headaches is still incompletely understood or completely unknown.

An alternative name for headaches originating from the spine is "vertebrogenic
headache". This term was proposed by Howard Vernon, D.C. a researcher and professor
from Canadian Memorial Chiropractic College to avoid the limitation created by the overly
narrow definition created by Sjaastad for cervicogenic headache.

Case Study 2

Post traumatic 57 year old female patient with significant cervical DJD and multiple broad based
HNPs. HA for 6 months duration since MVA, patient was taking aspirin or Tylenol on a daily basis.
A mild C7 radiculopathy was also present with variable intensity reported between visits. Her HA
was the primary complaint. She had regular chiropractic care for 6 months without any reduction in
HA intensity.

Treatment: Class IV laser was used in the suboccipital and posterior cervical
intrinsic musculature as well as scapular elevator musculature.

Results: There was no change in the patient's symptoms following the first two
treatments. Following the third laser treatment the patient had complete resolution of HA symptoms.
On a follow-up visit five months later, there were no episodes of HA reported.

Dr. True is a Board Certified Chiropractic Neurologist practicing in Stuart, Florida.
He is the Coauthor of the textbook "Myelopathy, Radiculopathy, and Peripheral Entrapment Syndromes".
He can be reached for patient consultation or case discussion at 772-219-9983.